June 26, 2003. Comment by Trifold:-
I'm glad reversal has helped you. But I did want to ask why you think sperm backpressure continued to be a problem after ruptures developed in your epidydimi: Why didn't sperm just leak out of those? Also, did you look into any of the other treatments recommended for pvp other than testosterone therapy and reversal? Reversal seems extreme, in that it is risky and expensive. Worse, it might make you fertile again! (BTW, *are* your fertile again?) Finally, you say one doctor told you doctors expect sperm production to decrease after vasectomy. I have never heard this before. Did the doctor say what would cause this? What I have read does not suggest a possible mechanism for reduced sperm prodcution after vasectomy. It seems while men continue to produce the same amount of sperm as before, they don't develop pvp like you did. I do occasionally get mild tenderness in my epi. But ejac. always causes it to go away.
July 25, 2003. Comment by Steve:-
Hi, Trifold. I had different types of pain, some of which was cyclical, and concurrent with others. Difficult to describe - didn't know exactly what was going on then, and find it hard to describe now.
I had a general sensitivity in the scrotum that was continuous, but did vary in intensity. For example, when I went to the urologist for yet another exam, he would do a routine check of the vas. In almost all cases, this would cause me significant pain and soreness that would last for up to a week - and this was a gentle examination. When I had this level of sensitivity we didn't even try sex - the few times we did, it became impossible to continue or I was deeply regretful later. I think most of this was caused by the granulomas I developed.
So that's one type of pain. The other occurred when my epidydymis became swollen. This was cyclical - would last for weeks or months. Invariably the doctor would prescribe antibiotics, which didn't help. This pressure / pain seemed to be exclusively caused by backpressure - and again only got worse after ejaculation.
I was definitely having ruptures as I had several granulomas. Can't explain why things seemed to back up and cause the problems.... I think most of the pain caused by the doctor's examination was related to the granulomas - but again am not certain about that.
Also had a generalized ache that was pretty constant throughout the scrotum. This seemed to occur whether I had the more acute pain that seemed to be related to granulomas or the pressure / pain that seemed to be related to the swollen epidydimus(i?). My urologist speculated that this could have been caused by the autoimmune responses related to sperm leaking in the body - described it as my body attacking itself as it attacked not only the sperm but the surrounding tissue... again, only speculation - although I would certainly regard it as informed speculation - since there appear to be no scientific studies on any of this....
PVP treatments I was willing to subject myself to:
* anti-inflammatories (both over the counter and prescription)
* antiobotics (waste of time)
* testosterone therapy (no downside to this)
* reversal
I considered all other surgical treatments as holding more risk that I was willing to assume. Given my belief and my doctor's concerns about autoimmune issues, I was not willing to consider converting to an open-ended. I also didn't want to subject myself to surgery and then more surgery if this didn't work. My intuition told me that a reversal would deal with most of my pain - fortunately it has. And yes, I am now fertile - my wife went back on the pill.
July 27, 2003. Comment by webmaster:-
Steve, I'm glad that reversal helped you and I'd like to thank you for your contributions here, and for being etremely honest and open. It's great that people like you are willing to share your experiences and give us this feedback - it can only be for the benefit of those in the same position, and a stark warning to those considering!
July 28, 2003. Comment by Trifold:-
Thanks Steve for this info. It sounds as if your pvp case is one that really did require reversal, prob. due to antisperm antibodies. BTW, there is research on antisperm antibodies both in vasectomised men and non vasectomised. It is known, for example, they do not lead to an increase in autoimmune disease. But it's true, they are not viewed as a common cause of pvp. Not surprising, since about 70% of men with vasectomies develop antisperm antibodies, but they don't develop pvp like yours! Anyway, when I was considering vasectomy I figured reversal would be my solution if I was one of the rare ones who developed pvp that lasted more than a few months and who couldn't be helped by any of the less drastic measures. Glad reversal worked for you. (Sorry your wife is back on the pill though.)
July 28, 2003. Comment by Lisa:-
I'm not sorry I'm on the pill...keeps things normal and on even keel...now that I'm over 40, I'm seeing women my age that go kind of crazy each month. This doesn't happen to me. So, don't feel bad...we have a happy ending!
October 19, 2003. Comment by Greenfeather:-
Glad everything worked out for y'all in the end. Steve, about the granulomas, I have the same thing albiet no where as bad. I had a physical this week and the doctor was hell bent on feeling them. I told him I'd rather he not touch them as this was a sore time and I rather not have them prodded at. He relented and we continued with the rest of the exam. He had a closed ended and he said he was having back pressure problems at times as well. Sounds like yet another dissertation in the making.
November 15, 2003. Comment by Steve:-
Hi, Greenfeather. Sorry about the painful granulomas. Evidently they aren't painful for most. (Yet another risk that I wasn't informed about pre-vasectomy...). I hope that he'll actually proceed with research / dissertation! My general feeling is that the urologists don't want to study this - they'd rather proceed with business as usual, and not risk the revenue stream associated with vasectomies - just one guy's opinion!
January 8, 2004. Comment by Darrel:-
Steve, I think your posts have been the most helpful in my search. Here's a quick rundown of my story. I had a vasectomy on 12/18/03 - closed ended and titanium clipped. The procedure went ok - just the normal pain for a few days. 2 weeks later, I was pain-free and had sex. 2 days after that, I experienced discomfort (a dull ache) throughout the day. The next morning, I had sex again. 2 hours later, I was in immense pain. I was folded over screaming like a baby. I almost called 911 but figured out that they would just end up calling my doctor anyway. I called the doctor and he saw me in his office. He said that he thinks it's infected but thought it was strange that it's infected 2+ weeks after the procedure. He gave me antibiotics that I am almost done with. I still hurt, it's hard to walk. The constant pain you talked about having - does it last forever basically? Plus does the post-sex problem I described sound like what you had? After your reversal, have you had any pain at all before/during/after sex? Thank you.
January 8, 2004. Comment by Steve:-
Hi, Darrell. I'm sorry about your situation. Your symptoms sound a bit different from mine. The intensity of your post-sex pain you describe is worse than anything I experienced. Occasionally I would experience an acute piercing pain in the testicles during sex. While it was usually bad enough to end that sexual encounter, I was never in the severe pain you describe. The chronic ache/pain for me was cyclical - much worse at times, at infrequent times it would actually go away. The reversal resolved virtually all of the chronic pain. I will occasionally get a small ache after sex that reminds me of the pain I used to have - but it's not bad, and does not affect the quality of my life...
Good luck. You may want to post over at the google list to see if David or others have any advice for you. Email me directly if you'd like to correspond further.
February 8, 2004. Comment by Mark:-
Does anyone out there know of specific studies related to PVP and if a reversal is effective. My insurance company denied my reversal but stated that I can appeal their decision if I can show that there are studies related to a vasectomy and PVP and how reversals can help. Any help would be appreciated.
February 8, 2004. Comment by Lisa:-
Mark--You could try contacting our doctor, Michael Witt, in Atlanta. He can cite some studies for you. He wrote a letter to our insurance company, which pursuaded them to pay. hope this helps! Lisa
February 8, 2004. Comment by webmaster:-
Mark. I think your insurance company should be aware of the research. Take a look at the medical journals section on this site medical | medical papers | medical journals from the main menu if you use internet explorer. There is a sub section titled pvp incidence and treatment that has some studies into reversal's effectivenes in treating pvp. You can always look at medline (national library of medicine) that is linked to from the journals page and search for additional studies. Please keep in contact and let us know how things work out. You might like to consider posting to the newsgroup for a wider discussion.
February 13, 2004. Comment by Mark:-
Thanks for the help. I went to my urologist on Monday and he said he would be happy to write a letter. I haven't been to him in about a year and a half. Why go if he can do nothing for the pain? My insurance company noticed that and was somewhat skeptical about my problems. I have checked out a few of the journal articles. Doesn't seem to be alot though. Maybe I need to do a broader search.
February 13, 2004. Comment by Lisa:-
Mark-If you need our doctor to release records for proof, we'll be happy to do so.
February 13, 2004. Comment by Mark:-
Lisa: Yes, that would be great. What do I need to do???
February 13, 2004. Comment by Mark:-
Do I need to contact Dr. Witt to get a letter written?? Do you have an email address or phone # for him???
February 14, 2004. Comment by Steve:-
Mark: it sounds like you have your ducks in a row re: the insurance company. Let me go over a few details, though. I worked in the insurance industry for 15 years, and know at least some of the ins and outs... don't give up on having your insurance company pay for this - and don't take their first 'no.' Almost all policies, whether they are self-insured by your employer or an insured plan by the insurance company, give you rights of appeal in case you have a requested service denied because it is not a covered benefit or they do not think it is a medically necessary service. Your attorney should know all about this. Stay very proactive here. Have your doctor document your symptoms, and quote the few relevant studies (I'm aware of 2) which indicate the success rate of reversals in treating pvp:
J Urol. 1997 Feb;157(2):518-20; Vasectomy reversal for treatment of the post-vasectomy pain syndrome
J Urol. 2000 Dec;164(6):1939-42; Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation
Best Wishes!
February 14, 2004. Comment by Mark:-
Steve: Thanks for the quick response. Yes, I'm working with Dr. Marks out of Tucson, AZ. He specializes in reversal for fertility and pain. I have spoken to him by phone on 2 different occasions over the past 1.5 years. We spoke for about 30 minutes each time. I've heard nothing but good things about him. I live over here in southeast New Mexico and am lucky that he is only about an 8 hour drive away. My surgery is scheduled for March 29th. I have an advocacy group that is part of my employer that will take all of the studies, my medical records and 2 letters of medical necessity from my PCP and my Urologist to my insurance company to fight for payment. So, I feel like everything is in order. I have spoken to an attorney about all of this and am waiting to see what my insurance company will do. No matter what, I will have it done regardless of who pays. Life is too short to feel like someone is kicking you between the legs. You, know what I mean.
I, of course, had none of these problems until after the vasectomy - NO pain, no dysfunction, etc. I have already educated my 13 year old son on never having a vasectomy done, never, never, never.
February 14, 2004. Comment by Mark:-
I was just wondering. Is your husband still pain free after the reversal? It has been 2 years since???
February 14, 2004. Comment by Steve:-
Hi, Mark. Yep - virtually pain free 2 yrs, 1 mo post reversal.
Getting into this late - have you found a urologist who knows anything about PVP? The only way I made any progress was to finally find Dr. Witt - who had incorporated the treatment of PVP into his practice, and kept (presumably, still keeps up!) with the latest thinking about potential treatments. If you haven't I suggest that you have to become the expert here. Do as David suggested - dig into the articles linked to here on the website. Find those relevant to what you have experienced, including those referencing the success rate of treating pvp with reversal. Take the articles to your physician - he should be the one organizing the information to get the benefit exception from your insurance company. If s/he's your average urologist, you'll have to be the one feeding the information. If you are attempting to have a reversal, be sure you're seeing a specialist who is an expert - don't trust your reversal to your average urologist who may only have done a few a year. I suggest seeing an infertility specialist - they probably have the most knowledge / expertise. Best wishes!
February 15, 2004. Comment by webmaster:-
15/2/04 david:- One further document that may be of use is the Christiansen & Sandlow article "Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome" published in 2003. You can only (strictly speaking) get it by purchasing it online - $7 US, but I'll email you a copy if you want. To purchase online there is a link on the bottom of the FAQ page. You can contact me at webmaster@vasectomy-information.com
It's a review of several papers, and one of it's conclusions is that reveral is effective in selected patients.
February 16, 2004. Comment by Mark:-
Could you please email the article to me. I'm under the gun here and will send all of my info to the insurance company in a few days. So I will need it rather quickly. Thanks.
February 24, 2004. Comment by Mark:-
Steve: Just got a call from my Insurance Company. They have agreed to pay 70% of the cost of my Vasectomy reversal for Pain!!! What a great day :-)
February 24, 2004. Comment by Lisa:-
Mark, that is great news!!! That's why we keep posting to this site...to let others know they don't have to suffer! Best wishes for a full recovery for you! Let us know.
February 26, 2004. Comment by webmaster-
A result!!! That's good news, and as Steve says please keep us posted.
February 26, 2004. Comment by Mark:-
I will certainly keep you posted after surgery on March 29th. Thanks again for the support
April 1, 2004. Comment by Mark:-
Steve & Lisa: Back from Tucson and the reversal. Obviously, still sore since the reversal on Monday. Dr. Marks was excellent and documented what he found once he got "in there". Apparently, the Dr. that did the original vasectomy cut the vas "very low" toward the testicle end and thus the pressure could not be spread out over the area. The epididymis was not blocked just pressured and a straight vas-to-vas was performed. I can tell there is some difference in the amount of PVP I am experiencing but it is still too soon to tell since I have post-op pain. I feel this was the correct path and will keep all posted as post-op pain subsides.
April 1, 2004. Comment by webmaster:-
Mark, I'm glad you are having good results from the reversal, and it's not the first time we have heard of PVP being caused by cutting too close to the epididymus. I'd be really grateful if you could submit your story for the site sometime, along with the latest news. Hope you keep us posted!
April 3, 2004. Comment by Mark:-
Steve: Just wondering.... After your reversal did you experience the need to frequently urinate?? I am "going" quite a bit and it appears that I am having difficulty emptying my bladder. I suspect it may be related to swelling down in that area or some type of relief regarding the pressure that was built up for so long. I will call the doc on Monday. Any thoughts?
April 6, 2004. Comment by Mark:-
Steve: Not sure what is going on here. Pain has increased. Pain extending up into the groin area on both sides. Still have swelling. Doctor suggested more ice and take it easier for the next 2-3 days. It has been 9 days since the reversal. Did your pain last that long? Tried going back to work today but pain was too much. Have only taken 1 pain pill since the operation. I guess I will need to take some more. This increased pain doesn't seem right. Any thoughts???
April 6, 2004. Comment by Lisa:-
Mark...remember, this was much more invasive a procedure than the original. Please...take it easy. Steve didn't move for 3 days after, and was still very sore and weak for a bit. Will make sure he sees your post and responds. Lisa
April 7, 2004. Comment by Steve:-
Hi, Mark. One word: drugs! I took plenty of pain pills after the surgery. This was pretty invasive! My doc prescribed percoset, which was great except that it caused hemmorhoids, which to me were more painful than the surgery itself. Metamucil chaser w/ percoset! Keep your chin up and don't try to tough this out - prescription help was great! Keep us informed!
April 21, 2004. Comment by Mark:-
Steve/Lisa: Well most of the post-op pain has gone. Unfortunately the pain still remains. My pain in the prostate area has increased significantly and the pain in the epididymis remains as well.
The surgeon is not really sure why but informed me that prior to surgery things may hurt worse, same or not at all after the surgery. The pain that I am feeling however is very similar to the pain I felt intially 2 years after the vas. Maybe my symptoms are gradually waning to the point of subsiding. Will keep you informed :-